Driver’s knee, also known as patellofemoral pain syndrome (PFPS) or iliotibial band syndrome (ITBS), is a common condition experienced by individuals who spend prolonged hours driving. It results from repetitive stress and poor posture, leading to discomfort, stiffness, and pain in the knee joint. Professional drivers, delivery personnel, and individuals who commute long distances are particularly susceptible to this condition. Physiotherapy plays a crucial role in both preventing and treating driver’s knee, ensuring pain relief and improved joint function.

Understanding Driver’s Knee

The primary cause of driver’s knee is prolonged knee flexion while driving, which places excessive strain on the patellofemoral joint and surrounding structures. Some key risk factors include:
1. Poor Seat Positioning: Improper seat height and distance from pedals lead to awkward knee angles.
2. Repetitive Motion: Frequent gear shifts, clutch usage, and braking increase stress on the knee.
3.  Muscle Imbalances: Weak quadriceps, hamstrings, and hip muscles contribute to improper knee alignment.
4. Lack of Movement: Sitting in a fixed position for extended periods reduces blood circulation and increases stiffness.
5. Existing Knee Conditions: Individuals with arthritis, previous knee injuries, or ligament weaknesses are more prone to developing driver’s knee.

The patient may feel dull or aching pain around or behind the kneecap, pain worsens after long periods of driving, swelling or inflammation in the knee joint, difficulty in fully extending or bending the knee, clicking or grinding sensation when moving the knee, weakness or instability in the knee while walking.
If left untreated, driver’s knee can lead to chronic pain, reduced mobility, and long-term joint damage. Therefore, early intervention with physiotherapy is essential.
 

Role of Physiotherapy in Preventing and Treating Driver’s Knee

1. Postural Correction and Ergonomic Adjustments
A physiotherapist can assess a driver’s posture and recommend seat adjustments to minimize knee stress:
Adjust the seat height to keep the knees slightly bent at 120 degrees rather than a sharp 90-degree angle.
Position the seat to allow the feet to reach the pedals without excessive stretching.
Supporting the lower back with a cushion to maintain an upright posture.

2. Strengthening Exercises
Weak muscles contribute to poor knee alignment and increased strain. A physiotherapist will prescribe exercises targeting key muscle groups:
Quadriceps Strengthening:
· Straight Leg Raises
· Wall Sits
· Terminal Knee Extensions with Resistance Bands

Hamstring and Glute Activation:
· Bridges
· Hamstring Curls
· Clamshells

Hip Stabilization:
· Side-lying Leg Raises
· Hip Abduction with Resistance Bands
· Single-leg Balancing

Strengthening these muscles improves knee stability and reduces stress on the joint during driving.

3. Stretching and Flexibility Exercises
Tight muscles around the knee can increase pain and stiffness. Recommended stretches include:
· Quadriceps Stretch: Standing on one leg and pulling the opposite ankle toward the buttocks.
· Hamstring Stretch: Sitting with one leg extended and reaching toward the toes.
· Calf Stretch: Pressing the heel into the ground with the knee straight.
· IT Band Stretch: Cross-leg standing stretch or foam rolling.

Regular stretching before and after long drives enhances flexibility and prevents stiffness.

4. Manual Therapy and Soft Tissue Mobilization
Physiotherapists use hands-on techniques such as:
· Myofascial Release: To reduce muscle tightness and improve blood flow.
· Joint Mobilization: To improve knee movement and alignment.
· Trigger Point Therapy: To relieve deep-seated muscle knots contributing to pain.

5. Pain Management Techniques
To alleviate pain, physiotherapy may incorporate:
· Cold Therapy (Cryotherapy): Reducing inflammation using ice packs.
· Heat Therapy: Relaxes muscles and improves circulation.
· Electrotherapy (TENS, Ultrasound): Stimulating blood flow and reducing pain perception.
· Kinesio Taping: Provides knee support and reduces excessive movement stress.

6. Proprioception and Balance Training
To prevent knee instability and enhance coordination, exercises such as:
· Single-leg balancing
· Bosu ball squats
· Dynamic step-ups

It helps train the knee’s ability to handle load efficiently.

7. Lifestyle and Driving Habit Modifications
A physiotherapist can guide drivers on:
· Take frequent breaks (every 1-2 hours) to stretch and walk around.
· Use cruise control on highways to reduce pedal stress.
· Avoid excessive clutch use by practicing smooth gear transitions.
· Wear supportive footwear with adequate cushioning.

8. Rehabilitation for Severe Cases
In cases where the driver’s knee has led to significant functional limitations, a progressive rehabilitation program is required. This includes:
Gradual loading exercises to rebuild knee endurance.
Hydrotherapy to ease movement without excessive joint stress.
Gait training to correct walking patterns affected by prolonged pain.

Driver’s knee is a preventable and treatable condition that should not be ignored. Individuals can significantly reduce their risk of developing this condition by making ergonomic adjustments, strengthening key muscle groups, improving flexibility, and adopting healthier driving habits. Consulting a physiotherapist is the first step toward recovery if you experience persistent knee pain related to driving.